LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Friday, August 22, 2008

Re-priming the pump

As most of you already know, I’ve been working my way down the ladder of success for several years now. More the American nightmare than the American dream.

Even without diabetes my income would be waaaaaaaaay down, given the economy and the planet-killing asteroid called digital imaging that hit my old industry. I’m not too bitter, for the most part, because I am a better person now. A happier person.

But lately, I’ve been having a problem with Dawn. Nope, she’s not a co-worker, boss, or patient. I’m talking about Dawn-Phenomena (sounds sort of like a stage name for a stripper, doesn’t it?).

As the sun creeps towards the horizon my internal rooster, in the form of circadian rhythms, sends a lethal cocktail of hormones coursing through my blood stream. My liver kicks into overdrive in the pre-dawn light. My alarm goes off and my blood sugar is 248. Crap.

No amount of creative use of pen syringes will counteract Dawn. If I set my alarm clock earlier to try to beat her to the punch she catches on, clever parasite that she is, and she sets her alarm even earlier. I find myself fighting a re-guard action. Burning the bridges as I retreat from the enemy. Humalog to knock down the highs retroactively.

Pumpers don’t have this problem.

I didn’t used to have this problem.

That’s because I used to be a pumper.

A quick recap of the sad tale: it’s all the fault of insurance. I used to have good diabetic coverage on a personal policy that cost a fortune, and got more expensive every year. Ultimately, it was unrealistically expensive. The year I threw in the towel, they raised it 45% to something around $660 bucks per month. At that time I had been working at the clinic for about a year and felt like I had found a home. But it was scary. I had been self-employed for two decades. Taking insurance, and being T-1, I was setting myself on the path to permanently “working for the man.” It was more than scary, it was terrifying.

But it had to be done. I closed my eyes, took a breath, and prepared to jump off the cliff. But at the last moment I grabbed the phone and called the lady who over-sees the clinic insurance instead.

She “researched” and called me back a week later, assuring me pump stuff was fully covered and that I’d only have to make a $15 or $20 med co-pay. I was elated and jumped off the cliff.

To the jagged rocks below.

She is apparently an incompetent boob. Like most plans, I later learned, pump stuff is considered Durable Medical Equipment. WTF? OK, I can see that the pump is durable, but what the fuck is durable about an infusion set you wear three days and then pitch?

Well, no one ever said life was fair. The clinic’s DME coverage was 50%. I actually got approval for the CGM sensors, but they too are considered durable. That means I still pay half of retail, so I wear them longer than would be strictly smart to do so because I simply can’t afford to do otherwise. The pump stuff was just too much to pay for what with gas, and food, and electricity, and phones, and car insurance, and taxes, and…

I had to pack my pump up in a box and go back to shots.

At first I was outraged. Then I enjoyed being un-tethered. Then I got in control. Then I spun hopelessly out of control, thanks to Dawn.

Meanwhile, my boss started searching out better insurance. Looks like next month it could be a whole new world-order for me. I got to thinking about pumps again. At a trade show I talked to the Animas folks, who had one of their pumps in a fish bowl full of water at their booth. I was wearing a “professional” badge so they nearly soaked my shoes with drool.

Rep: would you like a case of info packs for your patients?

No, I’m not going to recommend a pump I haven’t tried. Can you get me a loaner for a month?

Rep: Absolutely, no problem, we’ll make it happen.

Then they discovered I’m not a CDE. Only CDEs get such perks, apparently. To add insult to injury a Nurse Practioner friend of mine invited me to a lunch meeting with an Animas Rep. My friend wanted to hire me to be the pump trainer for her practice, as a side job now-and-again on my days off.

Animas: can’t be done. He’s not a nurse.

Now my friend could be a certified pump trainer. All she had to do was watch one pump training session and they’d rubber stamp her. “That’s just plain crazy,” she told the rep, and pointing to me, said “I don’t know even 1% of what he knows about pumps.”

Animas: that’s just the way it is.

The same thing happened with Dex Com. Not being a nurse, what could I possibly know about continuous glucose monitoring?

Accu-Chek has promised a Spirit Pump for me to test drive. We’ll see. It has brilliant software and the best designed infusion set I’ve ever seen; but it requires both a separate meter and a PDA to run the system. Seems like quite a few boxes to me. One thing I do like is that they give you two pumps.

What? You ask.

All the other players in the pump market will FedEx you a replacement pump if yours craps out. But that’s a long 24 hours, don’t cha’ think?

Accu-Chek’s solution (mainly a marketing ploy, but a good one) is to just give you two pumps from the get-go so you have a spare on hand just-for-incase. Now, before you get too excited and plan to share your spare with an uninsured friend, Accu-Chek is a step ahead of you. Sorry. The spare pump is like the little tape machine from Mission Impossible. It is designed to self-destruct. Not in five seconds, thank goodness, but in 180 days.

They also, like Med-T have skins to personalize it, and the display can “flip” so you can read the pump right-side-up no matter how you position it. Oh, and they also have a really creative set of assorted cases, straps, and so-forth for wearing it.

Their super-slick and creative info kit has so many healthy-looking obviously non-diabetic models in it that I actually threw-up.

That said, I’m yet to use the system, so I can’t really report on what it is like in the real world.

About the same time that all of this was happening, the new kid on the block sent me a post card. Insulet Corp wanted to know if I’d like a dummy pod to wear for a few days to “experience” what it would be like to be a I-Corp pumper with their OmniPod.

What the hell? I sent it in. Or maybe I went to their web site. I don’t recall. But it sure came fast. And this was just to me as a diabetic patient. They had no clue what I do for a living.

Actually, I found the whole OmniPod concept fascinating from the very start. I-Corp, as I’m sure you all know, has unplugged the pump. It really is thinking outside the box. You wear a disposable “pod” on your body that has all the mechanical parts of an insulin pump, while the brains of the system are in a PDA-type device that you can stash anywhere on, or around, your body.

The pod has the insulin, infusion set, etc. Amy over at Diabetes Mine was one of the first high-profile folks I knew of who got one. She went on a quest that bordered on a crusade to get it. I think highly of Amy. Amy thinks highly of OmniPod. Hmmmmm…

But still, that pod looks pretty big to me.

So my sample pod came earlier in the week. I opened the box and it looked HUGE. They also sent me a cute little CD disc that was cut-out into the shape of the PDA-type device. Huh. This must have cost them a fortune.

Anyway, it was a crappy, busy week. So the box sat on my desk. Then, on the weekend I got it out again and took the pod out of the wrapper. It felt heavy. Yuck. But still. I really like being un-tethered, but I miss the control of the pump.

This might be the way to have my cake and eat it too. Oh, and then I could bolus for the cake with the push of a button again. Oh yeah.

The OmniPod “demo kit” box asks “Where will you wear yours?” in ghastly puke-green and baby blue letters worthy of Med-T. Hmmmmmmmmm…..Where will I wear mine?

The top five suggestions from I-Corp:

(1) Arm

(2) Abdomen

(3) Back

(4) Leg

(5) Other. Other? Like, what? Your forehead?

Can you guess where I chose?

Arm. Why? Well, I don’t use them for anything anyway, so it seemed logical to me. I grabbed my beard trimmer and shaved my right bicep. I pulled off the sticky pads and slapped it on my arm. Then I jumped back into bed and rolled around to see how annoying it would be to sleep with.

You don’t really notice it. Once it is on your skin you don’t feel the weight. It reminds me a little of the transmitter on the first and second generations of the Med-T CGMs; before they stole the Roswell Alien sea-shell transmitter that I love so.

I might just like this pod approach. A lot.


Blogger Jonah said...

On MDI, NPH exists for those whom Dawn heckles.

I have inconsistant visits from Dawn, so I don't take plan for them. I'd go hypo when she didn't come if I planned for when she does. Grrr.

7:14 PM  

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